CT densitometry of pulmonary nodules in a frozen human thorax

The influence of (1) calcium concentration, (2) exposure technique, (3) reconstruction algorithm, (4) nodule size, and (5) nodule location on the CT attenuation values (CT density) of pulmonary nodules was examined in a frozen human thorax. Nodules with calcium concentrations of 0-310 mg/ml and diameters of either 0.95 or 1.59 cm were inserted into a frozen, unembalmed human thorax. The nodules were placed either at the lung apex or 4 cm below the tracheal carina. Each nodule was scanned on a GE CT 9800 scanner; five different exposure techniques were used. The slice thickness was uniformly 1.5 mm. As expected, increasing the kilovoltage caused a significant decrease in CT nodule density in all nodules with calcium concentrations greater than 80 mg/ml. The inverse relationship between kilovoltage and nodule density was exaggerated with increasing calcium concentration. A high-resolution (bone) algorithm gave a significantly higher CT number than did a smoothed (standard) algorithm, regardless of nodule size and location, but this difference could be attributed almost entirely to the edge-enhancement effect of the bone algorithm. The CT density of the larger nodules was significantly higher than that of the smaller nodules at calcium concentrations greater than 65 mg/ml for both standard and bone algorithms. Densities were significantly higher in the mid lung than in the apex with a standard algorithm, but this was not the case with a bone algorithm. The GE CT 9800 scanner had a linear response between CT density and increasing calcium concentration within the confines of a human thorax. A high-resolution (bone) reconstruction algorithm has higher spatial resolution but does show an edge-enhancing effect not found with the smoothed algorithm. Two major variables in CT densitometry for pulmonary nodules are the kilo electron voltage of the X-ray beam and the reconstruction algorithm used; these two parameters should be standardized, with a high kilovoltage and high-resolution algorithm favored on the GE CT 9800 scanner.